1
|
Ueda M, Tetsunaga T, Tetsunaga T, Nishida K, Takatori R, Shitozawa H, Uotani K, Shinohara K, Oda Y, Ozaki T. Insomnia among patients with chronic pain: A retrospective study. Medicine (Baltimore) 2024; 103:e39113. [PMID: 39121265 PMCID: PMC11315514 DOI: 10.1097/md.0000000000039113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/08/2024] [Indexed: 08/11/2024] Open
Abstract
Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (-) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.
Collapse
Affiliation(s)
- Masataka Ueda
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Tomonori Tetsunaga
- Department of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiichiro Nishida
- Division of Chronic Pain Medicine and Division of Comprehensive Rheumatology, Locomotive Pain Center, Okayama University Hospital
| | - Ryo Takatori
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisakazu Shitozawa
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University
| | - Kennsuke Shinohara
- Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| |
Collapse
|
2
|
Toropova A, Björk Brämberg E, Bergström G. Return to Work Trajectories of Swedish Employees on Sick-Leave Due to Common Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10216-9. [PMID: 38907784 DOI: 10.1007/s10926-024-10216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership. METHODS Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches. RESULTS Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder. CONCLUSION The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.
Collapse
Affiliation(s)
- Anna Toropova
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden.
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institute, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| |
Collapse
|
3
|
Gorcenco S, Karremo C, Puschmann A. Patients' Perspective in Hereditary Ataxia. CEREBELLUM (LONDON, ENGLAND) 2024; 23:82-91. [PMID: 36525215 PMCID: PMC10864479 DOI: 10.1007/s12311-022-01505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Hereditary ataxia represents a heterogeneous group of rare disorders with the chronic progression of motor symptoms that often become debilitating. Many forms include additional neurological, cognitive, or other symptoms. Most of these disorders lack specific treatment. We aimed to investigate aspects of patients' quality of life, experiences, and expectations. Patients with a diagnosis of hereditary ataxia were identified from our center's diagnostic register, direct referrals, and from a patient organization. We designed a questionnaire with 32 multiple-choice or open-ended questions on disability and impairment of daily life activities, the perceived effect of symptomatic and supportive therapies, coping strategies, and how they used and experienced various sources of information about their neurological disease. We also included the EQ-5D-3L quality-of-life instrument. Results were analyzed statistically for gender, age, and groups with and without a genetic diagnosis, and were compared to published data from the general population. Seventy-five patients returned the questionnaire. Patients reported considerable disease-related disability and impairment and had significantly lower quality-of-life scores than the general population. Physiotherapy and support from family or friends were important for patients' overall well-being. Patients with a genetic diagnosis had a lower average age at onset and felt more well-informed about their disease than patients without a genetic diagnosis. Patients used internet sources but relied primarily on their doctors to obtain information about their disease. Our study provides insights into hereditary ataxia patients' experiences that can lead to improvements in medical and nursing care for these patients.
Collapse
Affiliation(s)
- Sorina Gorcenco
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden.
| | - Christin Karremo
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden
| | - Andreas Puschmann
- Neurology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Getingevägen 4, 22185, Lund, Sweden
| |
Collapse
|
4
|
Kiwanuka O, Lassarén P, Thelin EP, Hånell A, Sandblom G, Fagerdahl A, Boström L. Long-term health-related quality of life after trauma with and without traumatic brain injury: a prospective cohort study. Sci Rep 2023; 13:2986. [PMID: 36805021 PMCID: PMC9941121 DOI: 10.1038/s41598-023-30082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
To purpose was to assess and compare the health-related quality of life (HRQoL) and risk of depression two years after trauma, between patients with and without traumatic brain injury (TBI) in a mixed Swedish trauma cohort. In this prospective cohort study, TBI and non-TBI trauma patients included in the Swedish Trauma registry 2019 at a level II trauma center in Stockholm, Sweden, were contacted two years after admission. HRQoL was assessed with RAND-36 and EQ-5D-3L, and depression with Montgomery Åsberg depression Rating Scale self-report (MADRS-S). Abbreviated Injury Score (AIS) head was used to grade TBI severity, and American Society of Anesthesiologists (ASA) score was used to assess comorbidities. Data were compared using Chi-squared test, Mann Whitney U test and ordered logistic regression, and Bonferroni correction was applied. A total of 170 of 737 eligible patients were included. TBI was associated with higher scores in 5/8 domains of RAND-36 and 3/5 domains of EQ-5D (p < 0.05). No significant difference in MADRS-S. An AIS (head) of three or higher was associated with lower scores in five domains of RAND-36 and two domains of EQ-5D but not for MADRS-S. An ASA-score of three was associated with lower scores in all domains of both RAND-36 (p < 0.05, except mental health) and EQ-5D (p < 0.001, except anxiety/depression), but not for MADRS-S. In conclusion, patients without TBI reported a lower HRQoL than TBI patients two years after trauma. TBI severity assessed according to AIS (head) was associated with HRQoL, and ASA-score was found to be a predictor of HRQoL, emphasizing the importance of considering pre-injury health status when assessing outcomes in TBI patients.
Collapse
Affiliation(s)
- Olivia Kiwanuka
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. .,Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - Philipp Lassarén
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eric P. Thelin
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Hånell
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Gabriel Sandblom
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Ami Fagerdahl
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Lennart Boström
- grid.416648.90000 0000 8986 2221Department of Surgery, Södersjukhuset, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
5
|
Hallin K, Larsson U, Schart-Morén N. Do Patients Aged 85 Years and above Benefit from Their Cochlear Implants? Audiol Res 2023; 13:96-106. [PMID: 36825948 PMCID: PMC9952005 DOI: 10.3390/audiolres13010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
The present study aims to investigate the usage and benefits of cochlear implants (CIs) in elderly patients aged ≥85 years, including their device-handling issues, follow-ups, and the influence on their well-being. The patients answered one questionnaire regarding quality of life, EQ5D-3L, and one questionnaire, obtained from the Swedish CI quality register, regarding usage, handling, satisfaction, remaining difficulties, etc. The medical records were searched for the implantation date, implant model, speech processor model, monosyllabic (MS) word scores, infections over the implant, and compliance regarding scheduled visits to the clinic. The results show that most elderly patients are satisfied full-time users of their implants. Even though most patients had no problems handling their CI, handling issues must be considered. Recurring guidance and training on device operation are needed. We suggest that follow-up visits are essentially needed for this group of patients on a regular basis. CI surgery is considered a safe treatment, even for the elderly. Upgrads to new external equipment (e.g., sound processors) should not be excluded because of their age. The results suggested that the CI positively affected their well-being. This study was approved by the Swedish Ethical Review Authority (5/10-2021, Dnr: 2021-04970).
Collapse
|
6
|
Bartels SL, Johnsson SI, Boersma K, Flink I, McCracken LM, Petersson S, Christie HL, Feldman I, Simons LE, Onghena P, Vlaeyen JWS, Wicksell RK. Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project. BMJ Open 2022; 12:e059152. [PMID: 35428645 PMCID: PMC9014062 DOI: 10.1136/bmjopen-2021-059152] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain. METHODS AND ANALYSIS The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare. ETHICS AND DISSEMINATION The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public. TRIAL REGISTRATION NUMBER NCT05066087.
Collapse
Affiliation(s)
| | - Sophie I Johnsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Orebro, Sweden
| | - Ida Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Orebro, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Suzanne Petersson
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Hannah L Christie
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands
| | - Inna Feldman
- Department of Public Health and Caring Science, Uppsala Universitet, Uppsala, Sweden
| | - Laura E Simons
- Department of Anaesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Patrick Onghena
- Research Group on Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Pain Clinic, Capio St. Göran Hospital, Stockholm, Sweden
| |
Collapse
|
7
|
Bakken AG, Eklund A, Warnqvist A, O'Neill S, Axén I. The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:903. [PMID: 34706706 PMCID: PMC8549416 DOI: 10.1186/s12891-021-04772-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics. Methods The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS − 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used. Results Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS − 11, a B-coefficient of − 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures. Conclusion Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain. Trial registration The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04772-x.
Collapse
Affiliation(s)
- Anders Galaasen Bakken
- Department of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S-, 171 77, Stockholm, Sweden.
| | - Andreas Eklund
- Department of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S-, 171 77, Stockholm, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Karolinska Institutet, Nobels väg 13, S-, 171 77, Stockholm, Sweden
| | - Søren O'Neill
- Spine Centre Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500, Middelfart, Denmark
| | - Iben Axén
- Department of Environmental Medicine, Division of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S-, 171 77, Stockholm, Sweden
| |
Collapse
|
8
|
Yao Q, Liu C, Zhang Y, Xu L. Population norms for the EQ-5D-3L in China derived from the 2013 National Health Services Survey. J Glob Health 2021; 11:08001. [PMID: 33692898 PMCID: PMC7916444 DOI: 10.7189/jogh.11.08001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background EQ-5D-3L is one of the most commonly used instruments for assessing health-related quality of life and cost-utility analyses, but it is not yet available in China. This study aims to develop population norms for the EQ-5D-3L in China in order to encourage appropriate use and interpretation of the EQ-5D-3L instrument. Methods Data were extracted from the 2013 National Health Services Survey on a nationally representative sample of 188 720 participants. The utility index based on the 2018 Chinese preference-based value sets were calculated for the participants with different demographic and socio-economic characteristics. Differences in reported problems and visual analogue scale (VAS) and utility index scores were tested using a logistic, linear and tobit regression model, respectively. Results The Chinese respondents were less likely to report problems on the EQ-5D dimensions compared with most populations in other countries. Pain/discomfort was the most commonly reported problem (12.6%). This resulted in a high ceiling effect (84.19%) on the utility index and high mean scores for the utility index (0.985 ± 0.056) and VAS (80.91 ± 13.74) in the Chinese population. Those who were younger, better educated, employed, married, had no illness condition, lived in a more developed region and had a higher income obtained higher scores in both VAS and utility index. The VAS and utility index scores were also associated with gender, residency and lifestyles, but not always in a consistent way. Male and rural residents had a higher VAS score but not in the utility index compared with their female and urban counterparts. Conclusions This study provides national population norms for the EQ-5D-3L based on the 2018 Chinese preference-based value sets. The norms can be used as a reference for health evaluation studies. Cautions need to be taken for presenting and interpreting the utility index results given the high ceiling effect of the EQ-5D-3L instrument.
Collapse
Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Yaoguang Zhang
- Centre for Health Statistics Information, National Health Commission, Beijing, China
| | - Ling Xu
- China Health Human Resources, National Health Commission, Beijing, China
| |
Collapse
|
9
|
Health and motivation as mediators of the effects of job demands, job control, job support, and role conflicts at work and home on sickness presenteeism and absenteeism. Int Arch Occup Environ Health 2020; 94:409-418. [PMID: 33099673 PMCID: PMC8032575 DOI: 10.1007/s00420-020-01591-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/07/2020] [Indexed: 12/02/2022]
Abstract
Purpose The first objective was to contribute to a better understanding of the contrasting and paradoxical results in studies of work environment factors and sickness presence and sickness absence. A second objective was to examine if, and under what conditions, employees choose to replace sickness absence with sickness presence, i.e., so-called substitution. Methods The study utilizes a large body of cross-sectional questionnaire data (n = 130,161) gathered in Sweden from 2002 to 2007 in connection with a comprehensive health promotion initiative. Health and motivation were analyzed as mediators of the effects of five job factors, job control, job support, job demand, role conflict and “work to family conflict” on sickness presence and absence. Results The results concerning job demands indicate substitution in that increased job demands are associated with increased presenteeism and reduced absenteeism. The direct effect of higher job support was increased absenteeism, but via the health and motivation paths, the total effect of more social support was health-promoting and associated with a reduction in sickness absence and sickness presence. High job control emerged as the most pronounced health-promoting factor, reducing sickness presenteeism as well as absenteeism. More role conflicts and work-to-family conflicts were directly and indirectly associated with decreased health and increased absenteeism as well as presenteeism. earlier research. Conclusion The mediation analyzes shed light on some of the paradoxes in research on sickness presenteeism and sickness absenteeism, especially regarding job demands and job support. The substitution effect is important for workplace policy and occupational health practice.
Collapse
|
10
|
Assi H, Persson A, Palmquist I, Öberg M, Buchwald P, Lydrup ML. Sexual and functional long-term outcomes following advanced pelvic cancer and reconstruction using vertical rectus abdominis myocutaneous and gluteal myocutaneous flap. Eur J Surg Oncol 2020; 47:858-865. [PMID: 33008672 DOI: 10.1016/j.ejso.2020.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION After extensive pelvic surgery for cancer two flap types are used at Skåne University Hospital (SUS), Sweden for perineal reconstruction: vertical rectus abdominis myocutaneous flap and gluteal flap with or without vaginal reconstruction. The objective was to study the long-term outcomes in patients treated for advanced pelvic cancer receiving a flap. METHOD Patients with pelvic cancer subjected to surgery including perineal reconstruction between January 2010 and August 2016 at SUS were included retrospectively. Participating patients were scheduled for an out-patient visit. Questionnaires addressing quality of life, (QLQ-C30 and EQ-5D) and sexual function (FSFI and IIEF) were filled in. Sensitivity test, using monofilaments on the gluteal/posterior thigh area, neovaginal measurements using silicon gauges and muscular functionality tests (timed stands test and stairs test) were performed. RESULTS Thirty-six (24 women, 12 males) out of 71 invited patients conceded participation. Patients scored a median of 85/100 regarding global health using EQ-5D. All women reported sexual dysfunction and 75% (9/12) of men reported severe erectile dysfunction. Neovaginal measurements showed adequate reconstructions. Sensitivity test implied decreased sensitivity on the operated side compared to the unoperated side in patients with gluteal flap. Both physical tests demonstrated adequate muscular functionality in everyday life activities after reconstructions using gluteal flap. CONCLUSION This long-term follow up after extensive surgery treating pelvic cancer with perineal flap reconstruction implies high quality of life, good muscular functionality and adequate neovaginal measurements. However sexual function is impaired among both sexes and sensitivity in the surgical area of the gluteal flap is decreased.
Collapse
Affiliation(s)
- Hanin Assi
- Department of AT/ST, Skåne University Hospital, Malmö, Lund University, Sweden.
| | - Anna Persson
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ingrid Palmquist
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Martin Öberg
- Department of Plastic Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Sweden
| |
Collapse
|
11
|
Galaasen Bakken A, Axén I, Eklund A, O'Neill S. The effect of spinal manipulative therapy on heart rate variability and pain in patients with chronic neck pain: a randomized controlled trial. Trials 2019; 20:590. [PMID: 31606042 PMCID: PMC6790043 DOI: 10.1186/s13063-019-3678-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recent experimental research has suggested that spinal manipulative therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain-regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in autonomic nervous system (ANS) regulation. A common way to study the ANS is to measure heart rate variability (HRV). It is not known whether deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as conditioned pain modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known whether this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain. Further, a secondary aim is to test whether a CPM test can be used to predict treatment response in a population of patients with recurrent and persistent NP. Method/design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference for the treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. HRV will be measured using a portable heart monitor. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. CPM will be measured with a standardized cold pressor test. Measurements will be performed three times during a 2-week treatment series. Discussion The study will utilize normal clinical procedures, which should aid the transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine whether a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP. Trial registration ClinicalTrials.gov, NCT03576846. Registered on 3 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3678-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anders Galaasen Bakken
- Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, S-171 77, Stockholm, Sweden.
| | - Iben Axén
- Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, S-171 77, Stockholm, Sweden
| | - Andreas Eklund
- Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, S-171 77, Stockholm, Sweden
| | - Søren O'Neill
- University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
| |
Collapse
|
12
|
Bergström C, Persson M, Mogren I. Psychosocial and behavioural characteristics in women with pregnancy-related lumbopelvic pain 12 years postpartum. Chiropr Man Therap 2019; 27:34. [PMID: 31417671 PMCID: PMC6691525 DOI: 10.1186/s12998-019-0257-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background There is insufficient evidence regarding psychosocial factors and its long-term association with persistent pregnancy-related lumbopelvic pain. The overall aim of this study was to investigate women with persistent pregnancy-related lumbopelvic pain 12 years postpartum based on psychosocial and behavioural characteristics using the Swedish version of the Multidimensional Pain Inventory (MPI-S) classification system. Material and methods This is a cross-sectional study based on a previous cohort. Data collection took place through a questionnaire. A total of 295 women from the initial cohort (n = 639) responded to the questionnaire giving a response rate of 47.3%. To determine the relative risk (RR) of reporting pain 12 years postpartum, a robust modified Poisson regression was used. This is the first study using the MPI-S as a predictive variable on women with persistent pregnancy-related lumbopelvic pain. Results The MPI-S classification procedure was carried out on a total of n = 226 women, where 53 women were classified as interpersonally distressed (ID), 82 as dysfunctional (DYS), and 91 as adaptive copers (AC). Women in the ID and DYS subgroups had a relative risk (RR) of reporting persistent pregnancy-related lumbopelvic pain 12 years postpartum that was more than twice as high compared to the AC subgroup (95% confidence interval (CI) in parenthesis): RR 2.57 (CI 1.76 - 3.75), p<0.0001 and RR 2.23 (CI 1.53 - 3.25), p<0.0001 respectively. Women in the DYS subgroup had more than 5 times increased risk of reporting sick leave the past 12 months compared to the AC subgroup (RR 5.44; CI 1.70 - 17.38, p=0.004). Conclusions The present study demonstrates that it is possible to classify women with persistent pregnancy-related lumbopelvic pain 12 years postpartum into relevant clinical subgroups based on psychosocial and behavioural characteristics using the MPI-S questionnaire.
Collapse
Affiliation(s)
- Cecilia Bergström
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
| | - Margareta Persson
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden.,2Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | - Ingrid Mogren
- 1Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden
| |
Collapse
|
13
|
Zrubka Z, Beretzky Z, Hermann Z, Brodszky V, Gulácsi L, Rencz F, Baji P, Golicki D, Prevolnik-Rupel V, Péntek M. A comparison of European, Polish, Slovenian and British EQ-5D-3L value sets using a Hungarian sample of 18 chronic diseases. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:119-132. [PMID: 31104218 PMCID: PMC6544595 DOI: 10.1007/s10198-019-01069-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND In the Central and Eastern European region, the British EQ-5D-3L value set is used commonly in quality of life (QoL) studies. Only Poland and Slovenia have country-specific weights. Our study aimed to investigate the impact of value set choice on the evaluation of 18 chronic conditions in Hungary. METHODS Patients' EQ-5D-3L index scores were calculated using the VAS-based Slovenian and European and the time-trade-off-based Polish and British value sets. We performed pairwise comparisons of mean index values by dimensions, diagnoses and age groups. We evaluated disease burden by comparing index values matched by age and gender in each condition with those of the general population of the CEE region in all four value sets. RESULTS Altogether, 2421 patients (55% female) were included in our sample with the average age of 55.87 years (SD = 17.75). The average Slovenian, European, Polish and British EQ-5D-3L scores were 0.598 (SD = 0.279), 0.661 (SD = 0.257), 0.770 (SD = 0.261) and 0.644 (SD = 0.279), respectively. We found highly significant differences in most diagnoses, with the greatest difference between the Polish and Slovenian index values in Parkinson's disease (0.265). Systematic pairwise comparison across all conditions and value sets revealed greatest differences between the time-trade-off (TTO) and VAS-based value sets as well as varying sensitivity of the disease burden evaluations of chronic disease conditions to the choice of value sets. CONCLUSIONS Our results suggest that the choice of value set largely influences the health state utility results in chronic diseases, and might have a significant impact on health policy decisions.
Collapse
Affiliation(s)
- Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary.
- Doctoral School of Business and Management, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary.
| | - Zsuzsanna Beretzky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
- Doctoral School of Business and Management, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Zoltán Hermann
- Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Tóth Kálmán u. 4, Budapest, 1097, Hungary
- Centre of Labour Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, Budapest, 1051, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Dominik Golicki
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Banacha 1B, Warsaw, 02-097, Poland
| | | | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| |
Collapse
|
14
|
Eklund A, De Carvalho D, Pagé I, Wong A, Johansson MS, Pohlman KA, Hartvigsen J, Swain M. Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial. Eur J Pain 2019; 23:1378-1389. [PMID: 31034102 PMCID: PMC6767754 DOI: 10.1002/ejp.1407] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022]
Abstract
Background Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients’ expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (a) patients’ expectations predicted short‐term outcome, and (b) psychological profile, pain intensity and self‐rated health modified the relationship between expectations and outcome. Methods Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patients’ expectations, psychological profile, pain intensity, activity limitation and self‐rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n = 593). Subjective improvement was measured at the fourth visit. Results Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR = 1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR = 1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile and self‐rated health did not modify the effect of expectation on outcome. Conclusions Baseline patients’ expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients’ expectations at the first visit to best inform prognosis. Significance This study confirms the importance of patients’ expectations in a clinical setting. Patients’ expectations predict the short‐term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self‐rated health did not modify this relationship.
Collapse
Affiliation(s)
- Andreas Eklund
- Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Diana De Carvalho
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Isabelle Pagé
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Arnold Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Melker S Johansson
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Michael Swain
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.,Institute for Musculoskeletal Health, School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
15
|
Janssen MF, Szende A, Cabases J, Ramos-Goñi JM, Vilagut G, König HH. Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:205-216. [PMID: 29445941 PMCID: PMC6438939 DOI: 10.1007/s10198-018-0955-5] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/08/2018] [Indexed: 05/18/2023]
Abstract
This study provides EQ-5D population norms for 20 countries (N = 163,838), which can be used to compare profiles for patients with specific conditions with data for the average person in the general population in a similar age and/or gender group. Descriptive EQ-5D data are provided for the total population, by gender and by seven age groups. Provided index values are based on European VAS for all countries, based on TTO for 11 countries and based on VAS for 10 countries. Important differences exist in EQ-5D reported health status across countries after standardizing for population structure. Self-reported health according to all five dimensions and EQ VAS generally decreased with increasing age and was lower for females. Mean self-rated EQ VAS scores varied from 70.4 to 83.3 in the total population by country. The prior living standards (GDP per capita) in the countries studied are correlated most with the EQ VAS scores (0.58), while unemployment appeared to be significantly correlated in people over the age of 45 only. A country's expenditure on health care correlated moderately with higher ratings on the EQ VAS (0.55). EQ-5D norms can be used as reference data to assess the burden of disease of patients with specific conditions. Such information, in turn, can inform policy-making and assist in setting priorities in health care.
Collapse
Affiliation(s)
- M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- EuroQol Group, Rotterdam, The Netherlands.
| | - A Szende
- Global Health Economics and Outcomes Research, Covance, Leeds, UK
| | - J Cabases
- Department of Economics, Public University of Navarra, Pamplona, Spain
| | | | - G Vilagut
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - H H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
16
|
Agreement of radiographic measurements and patient-reported outcome in 61 patients with Legg-Calvé-Perthes disease at mean follow-up of 28 years. J Pediatr Orthop B 2019; 28:100-106. [PMID: 30308553 DOI: 10.1097/bpb.0000000000000563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
It is unclear how patient-reported outcome in patients with Legg-Calvé-Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. At a mean follow-up of 28 years (15-42), 61 patients were investigated clinically and by plain radiography to evaluate the sphericity deviation score, femoral head enlargement and femoral neck growth inhibition. The patients also completed questionnaires for generic measures of health-related quality-of-life (ED-5D, EQ-visual analogue scale), the joint-specific Harris hip score and the nonarthritic hip score questionnaire. The radiographic measures sphericity deviation score, femoral head enlargement and femoral neck growth inhibition were strongly correlated with the joint-specific PROMs (Harris hip score and nonarthritic hip score) but not with EQ-5D and EQ-visual analogue scale. Inferior range of flexion and abduction and a positive Trendelenburg sign were associated with an inferior patient-reported outcome. Our findings highlight the importance of supporting femoral head re-modelling and containment and balancing trochanteric and femoral neck growth in patients with LCPD. To capture the whole picture of the outcome after LCPD, future studies should include a combination of radiographic measurements and joint-specific and generic outcome scores. Level of Evidence: Level III.
Collapse
|
17
|
Health Related Quality of Life in Individuals Transferred from a Needle Exchange Program and Starting Opioid Agonist Treatment. JOURNAL OF ADDICTION 2018; 2018:3025683. [PMID: 30662785 PMCID: PMC6313961 DOI: 10.1155/2018/3025683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
Background Opioid agonist treatment (OAT), for the treatment of heroin dependence, has been reported to improve overall health and lower mortality. Drug use and retention in treatment have often been used as measures of treatment success. More recently, however, researchers have suggested that measurements of quality of life should be an outcome in substance use treatment evaluations. In a recent randomized controlled trial we demonstrated high rates of successful rapid referral from a needle exchange program (NEP) to OAT. The aim of this study was to see whether an improvement in health related quality of life (HRQoL) could be seen at 3-month follow-up after starting OAT and whether it was associated with any baseline characteristics. We also wanted to compare our sample to a sample from the general population with regard to HRQoL. Methods This was a 3-month follow-up of 71 patients who started OAT. Measurements of HRQoL with EQ-5D (an instrument developed by the EuroQol group) were made at baseline and at three months. Results Mean EQ-5D VAS (visual analogue scale) for the study sample at baseline was 47.3, which was lower than a Swedish reference population reporting 83.3. Individuals reporting being prescribed a drug for a psychiatric condition had significantly lower EQ-5D index values. Improvement in EQ-5D index score was significantly less for individuals reporting previous overdoses (-0.10, p=0.025). Individuals reporting previous suicide attempts had significantly lower EQ-5D VAS score at baseline. A significant increase of the EQ-5D VAS difference over time was found with a mean difference of 10.94 (p=0.008) for the total sample. Conclusion To our knowledge this is the first time HRQoL as an outcome is reported in a population transferred from a NEP to OAT. Our results indicate that OAT can result in increased HRQoL, even with this type of rapid low-threshold referral.
Collapse
|
18
|
Cubi-Molla P, Shah K, Burström K. Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:253-270. [PMID: 29305706 DOI: 10.1007/s40271-017-0292-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Whether health values should be elicited from the perspective of patients or the general public is still an open debate. The overall aim of this paper is to increase knowledge on the role of experience in health preference-based valuation research. The objectives of this paper are threefold. First, we elaborate the idea of experience-based (EB) values under the informed value or knowledge viewpoint. We think the whole scope of knowledge about the health states involved in valuation exercises is not fully integrated in the previous literature. For instance, personal knowledge based on past experiences, contemplating the health state as a likely future condition, knowing someone who is currently experiencing the state, or just receiving detailed information about the health states; all these situations capture different nuances of health-related experience which are not explicitly referred to in valuation tasks. Second, we propose a framework where the extended factor of experience is detached from other factors interwoven into the valuation exercise. Third, we examine how experience is tackled in different value sets (EB or non-EB) identified via a literature review. We identified the following elements (and items) in a value set: health state (without description, described using a multi-attribute instrument, described using other method), reference person (the respondent; other person, similar/known/hypothetical), time frame (past, present, future), raters (public, representative/convenience; vested interest, patients/other) and experience (personal experience, past/present/future; vicarious experience, affective/non-affective; no experience). Forty-nine valuation exercises were extracted from 22 reviewed papers and classified following our suggested set of elements and items. The results show that the role of experience reported in health valuation-related papers is frequently disregarded or, at most, minimised to the item of personal experience (present)-linked to self-reported health.
Collapse
Affiliation(s)
| | | | - Kristina Burström
- Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Health Outcomes and Economic Evaluation Research Group, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden.,Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
19
|
Stavem K, Augestad LA, Kristiansen IS, Rand K. General population norms for the EQ-5D-3 L in Norway: comparison of postal and web surveys. Health Qual Life Outcomes 2018; 16:204. [PMID: 30340499 PMCID: PMC6194590 DOI: 10.1186/s12955-018-1029-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Background The EQ-5D-3 L instrument is a standardized questionnaire which was developed as a simple, generic measure of health for clinical and economic appraisal. To aid in the interpretation, scores are often compared with a normative group. The objectives of this study were 1) to provide population norms for the EQ-5D-3 L for Norway, and 2) to compare scores from postal and web surveys. Methods We conducted two surveys in samples that were aimed to be representative of the Norwegian general population: 1) a postal survey (n = 5000) and 2) a panel study with electronic data collection (n = 1936). For scoring the EQ-5D Index, we used the UK tariff. EQ-5D items were compared using multivariable ordinal logistic regression analysis and EQ-5D Index and EQ VAS scores using multivariable linear regression, adjusting for age, sex and education. Results In total 1131 (22.6%) responded to the postal survey and 977 (50.5%) to the web survey. The odds ratio (OR) for being in a higher score category on the Pain/Discomfort scale in the web survey was 1.25 (95%CI 1.04 to 1.50, p = 0.019) relative to the postal survey. The odds were similar in the other four dimensions. The EQ-5D Index and EQ VAS scores were similar in the postal and web surveys in the various strata according to age, sex and education, except for lower unadjusted and adjusted score for web respondents aged 41–50 years and for those with higher education (≥14 years) than postal respondents. Conclusions The distribution of scores for the EQ-5D descriptive system and its derived utility scores were rather similar in a postal survey and a panel web survey. Hence, these values were combined into a norm set for Norway.
Collapse
Affiliation(s)
- Knut Stavem
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway. .,Campus Ahus, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Lørenskog, Norway.
| | - Liv A Augestad
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ivar S Kristiansen
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kim Rand
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
20
|
Bergström C, Persson M, Nergård KA, Mogren I. Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord 2017; 18:399. [PMID: 28915804 PMCID: PMC5602957 DOI: 10.1186/s12891-017-1760-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/11/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pelvic girdle pain (PGP) is not always a self-limiting condition. Women with more pronounced persistent PGP (PPGP) report poorer health status compared to women with less pronounced symptoms. The knowledge concerning the long-term consequences of PPGP is limited, thus more knowledge in this area is needed. The overall aim was to study the prevalence and predictors of PPGP 12 years after delivery. METHODS This is a long-term follow-up study based on a previous cohort study that commenced in 2002. New questionnaire data 12 years postpartum were collected in 2014 and early 2015. The questionnaire was distributed to a total of 624 women from the initial cohort. RESULTS In total, 295 women (47.3%) responded to the questionnaire where 40.3% (n = 119) reported pain to a various degree and 59% (n = 174) reported no pain. Increased duration and/or persistency of pain, self-rated health, sciatica, neck and/or thoracic spinal pain, sick leave the past 12 months, treatment sought, and prescription and/or non-prescription drugs used were all associated with an statistically significant increase in the odds of reporting pain 12 years postpartum. Widespread pain was common and median expectation of improvement score was 5 on an 11-point numeric scale (interquartile range 2-7.50). More than one of five women (21.8%) reporting pain stated that they had been on sick leave the past 12 months and nearly 11% had been granted disability pension due to PPGP. No statistically significant differences were found between respondents and non-respondents regarding most background variables. CONCLUSIONS This study is unique as it is one of few long-term follow-up studies following women with PPGP of more than 11 years. The results show that spontaneous recovery with no recurrences is an unlikely scenario for a subgroup of women with PPGP. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. Moreover, widespread pain is commonly associated with PPGP and may thus contribute to long-term sick leave and disability pension. A screening tool needs to be developed for the identification of women at risk of developing PPGP to enable early intervention.
Collapse
Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | | | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| |
Collapse
|
21
|
Samano N, Bodin L, Karlsson J, Geijer H, Arbeus M, Souza D. Graft patency is associated with higher health-related quality of life after coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 2017; 24:388-394. [PMID: 28040753 DOI: 10.1093/icvts/ivw372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/19/2016] [Indexed: 01/30/2023] Open
Abstract
Objectives The objective of this study was to investigate whether graft patency was associated with higher health-related quality of life in coronary artery bypass grafting patients and to compare this study with the general Swedish population. Methods Patients were included from 3 randomized trials and 1 prospective cohort trial. The generic health-related quality of life instrument, EQ-5D (VAS and index) was used. Graft patency was assessed with computed tomography angiography. Patients were divided into 2 groups according to the number of occluded distal anastomosis: Group I with no to 1 occlusion ( n = 209) and Group II with 2 to 4 occlusions ( n = 24). Results Two hundred and thirty-three patients underwent computed tomography angiography at a mean of 7.5 (1-18) years post-operatively. The mean difference in EQ-VAS and EQ-5D index between Groups II and I after model adjustment was -19.8 (95% CI -25.3 to -14.3; P < 0.001) and -0.13 (95% CI -0.19 to -0.08; P < 0.001), respectively. The EQ-5D index for the study population was similar compared with the Swedish population, 0.851 and 0.832, respectively, with an effect-size of 0.112 (trivial). The EQ-5D index of the study population was higher compared with the ischemic heart disease group in the Swedish population, 0.851 vs 0.60, with an effect-size of 0.999 (large). Conclusions Graft patency was associated with higher health-related quality of life in coronary artery bypass patients. This patient group reported similar function and wellbeing compared to the general Swedish population and better health status than those in the same disease group in the general population. Clinical registration number Clinicaltrials.gov: NCT02547194 and the Research and Development registry in Sweden: 167861.
Collapse
Affiliation(s)
- Ninos Samano
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lennart Bodin
- Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mikael Arbeus
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Domingos Souza
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
22
|
Bergström G, Lohela-Karlsson M, Kwak L, Bodin L, Jensen I, Torgén M, Nybergh L. Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services. BMC Public Health 2017; 17:436. [PMID: 28494753 PMCID: PMC5427578 DOI: 10.1186/s12889-017-4329-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. METHODS The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. DISCUSSION The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed. TRIAL REGISTRATION ClinicalTrials NCT02563743 Sep 28 2015.
Collapse
Affiliation(s)
- G Bergström
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Centre for Occupational and Environmental Medicine, Stockholm County Council, SE-113 65, Stockholm, Sweden.
| | - M Lohela-Karlsson
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - L Kwak
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - L Bodin
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - I Jensen
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - M Torgén
- Department of Medical Science, Uppsala University, SE-751 85, Uppsala, Sweden
| | - L Nybergh
- Division of Intervention and Implementation Research in Worker Health, Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| |
Collapse
|
23
|
Hoefman RJ, van Exel J, Brouwer WBF. Measuring Care-Related Quality of Life of Caregivers for Use in Economic Evaluations: CarerQol Tariffs for Australia, Germany, Sweden, UK, and US. PHARMACOECONOMICS 2017; 35:469-478. [PMID: 28039617 PMCID: PMC5357482 DOI: 10.1007/s40273-016-0477-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Informal care is often not included in economic evaluations in healthcare, while the impact of caregiving can be relevant for cost-effectiveness recommendations from a societal perspective. The impact of informal care can be measured and valued with the CarerQol instrument, which measures the impact of informal care on seven important burden dimensions (CarerQol-7D) and values this in terms of general quality of life (CarerQol-VAS). The CarerQol can be included at the effect side of multi-criteria analyses of patient interventions or in cost-effectiveness or utility analysis of interventions targeted at caregivers. OBJECTIVE At present, utility scores based on relative utility weights for the CarerQol-7D are only available for the Netherlands. This study calculates CarerQol-7D tariffs for Australia, Germany, Sweden, UK, and US. METHODS Data were collected among the general population in Australia, Germany, Sweden, UK, and US by an Internet survey. Utility weights were collected with a discrete choice experiment with two unlabeled alternatives described in terms of the seven CarerQol-7D dimensions. An efficient experimental design with priors obtained from the Netherlands was used to create the choice sets. Data was analyzed with a panel mixed multinomial logit model with random parameters. RESULTS In all five countries, the CarerQol-7D dimensions were significantly associated with the utility of informal care situations. Physical health problems were most strongly associated with the utility for informal care situations. The tariff was constructed by adding up the relative utility weights per category of all CarerQol-7D dimensions for each country separately. CONCLUSION The CarerQol tariffs for Australia, Germany, Sweden, UK, and US facilitate the inclusion of informal care in economic evaluations.
Collapse
Affiliation(s)
- Renske J Hoefman
- Netherlands Institute for Health Services Research, PO Box 1568, Utrecht, The Netherlands.
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Engquist M, Löfgren H, Öberg B, Holtz A, Peolsson A, Söderlund A, Vavruch L, Lind B. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone. J Neurosurg Spine 2017; 26:19-27. [DOI: 10.3171/2016.6.spine151427] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy.
METHODS
Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5–8 years.
RESULTS
After 5–8 years, the NDI was reduced by a mean score% of 21 (95% CI 14–28) in the surgical group and 11% (95% CI 4%–18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26–53 mm) compared with 19 mm (95% CI 7–30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18–49 mm) compared with 19 mm (95% CI 7–32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13–0.45) compared with 0.14 (95% CI 0.01–0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as “better” or “much better” compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures.
CONCLUSIONS
In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.
Collapse
Affiliation(s)
| | | | - Birgitta Öberg
- 4Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping
| | - Anders Holtz
- 5Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala
| | - Anneli Peolsson
- 4Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping
| | - Anne Söderlund
- 6Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås; and
| | | | - Bengt Lind
- 2Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- 7Spine Center Göteborg, Gothenburg, Sweden
| |
Collapse
|
25
|
Abstract
BACKGROUND Legg-Calvé-Perthes disease (LCPD) is a disease in children leading to deformation of the femoral head and can be a promoter for early dysfunction of the hip and early osteoarthritis of the hip. The study of health-related quality of life, physical activity, and behavior patterns in patients with LCPD can reveal its consequences later in life and also contribute to a better understanding of the etiology of the disease. PATIENTS AND METHODS We identified 145 patients with LCPD diagnosed and treated at Uppsala University Hospital between 1978 and 1995. A total of 116 patients answered questionnaires regarding health-related quality of life (EQ-5D-3L), physical activity [International Physical Activity Questionnaire (IPAQ)], and hyperactive/inattentive behavior pattern [ADHD self-reporting symptom checklist (ASRS v1.1)] by interview. Patients were asked to report on fractures or soft-tissue injuries that required medical care. Medical charts were reviewed to determine age at onset of LCPD and treatment received. RESULTS Patients with LCPD had significantly lower EQ-5D-3L and EQ VAS scores than the Swedish general population in all age groups. A total of 28% of our patient group had ASRS scores indicating they are likely or highly likely to have an ADHD diagnosis. A lower EQ-5D-3L score was significantly correlated with a higher total ASRS v1.1 score (ρ=-0.309**). Over 90% of our patient group was physically active on a moderate or high level, despite 52% reporting either some or severe problems with pain according to the EQ-5D-3L questionnaire. Patients with high ASRS v1.1 scores (>16) had a significantly higher incidence of soft-tissue injuries than those with lower ASRS v1.1 scores. CONCLUSION The consequence of LCPD in adulthood was expressed in a lower quality of life compared with the Swedish general population. Despite this, the patients in our study reported a higher level of physical activity than the general population. A tendency toward hyperactive behavior pattern and high physical activity level may be present even in childhood and could contribute to the etiology of LCPD. LEVEL OF EVIDENCE A retrospective study, level II.
Collapse
|
26
|
Eklund A, Axén I, Kongsted A, Lohela-Karlsson M, Leboeuf-Yde C, Jensen I. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial. Trials 2014; 15:102. [PMID: 24690201 PMCID: PMC3984260 DOI: 10.1186/1745-6215-15-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 03/21/2014] [Indexed: 11/16/2022] Open
Abstract
Background Low back pain (LBP) is a prevalent condition and a socioeconomic problem in many countries. Due to its recurrent nature, the prevention of further episodes (secondary prevention), seems logical. Furthermore, when the condition is persistent, the minimization of symptoms and prevention of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies. Methods/Design This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating the effect and cost-effectiveness of preventive manual care (chiropractic maintenance care) in a population of patients with recurrent or persistent LBP. Four hundred consecutive study subjects with recurrent or persistent LBP will be recruited from chiropractic clinics in Sweden. The primary outcome is the number of days with bothersome pain over 12 months. Secondary measures are self-rated health (EQ-5D), function (the Roland Morris Disability Questionnaire), psychological profile (the Multidimensional Pain Inventory), pain intensity (the Numeric Rating Scale), and work absence. The primary utility measure of the study is quality-adjusted life years and will be calculated using the EQ-5D questionnaire. Direct medical costs as well as indirect costs will be considered. Subjects are randomly allocated into two treatment arms: 1) Symptom-guided treatment (patient controlled), receiving care when patients feel a need. 2) Preventive treatment (clinician controlled), receiving care on a regular basis. Eligibility screening takes place in two phases: first, when assessing the primary inclusion/exclusion criteria, and then to only include fast responders, i.e., subjects who respond well to initial treatment. Data are collected at baseline and at follow-up as well as weekly, using SMS text messages. Discussion This study investigates a manual strategy (chiropractic maintenance care) for recurrent and persistent LBP and aims to answer questions regarding the effect and cost-effectiveness of this preventive approach. Strict inclusion criteria should ensure a suitable target group and the use of frequent data collection should provide an accurate outcome measurement. The study utilizes normal clinical procedures, which should aid the transferability of the results. Trial registration Clinical trials.gov; NCT01539863, February 22, 2012. The first patient was randomized into the study on April 13th 2012.
Collapse
Affiliation(s)
- Andreas Eklund
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Nobels v13, S-171 77 Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
PURPOSE To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data. METHODS Approximately 45,000 individuals valued their current health status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents' answers on a self-rated health (SRH) question was assessed. RESULTS Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly. CONCLUSIONS A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals' overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies.
Collapse
|
28
|
Wu XY, Ohinmaa A, Johnson JA, Veugelers PJ. Assessment of children's own health status using visual analogue scale and descriptive system of the EQ-5D-Y: linkage between two systems. Qual Life Res 2013; 23:393-402. [PMID: 23893344 DOI: 10.1007/s11136-013-0479-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of the study is to derive a scoring system for the EQ-5D child-friendly version (EQ-5D-Y) from a population-based sample of children based on their own health state assessments on the descriptive system and the visual analogue scale (VAS). METHODS We used data from the 2008 and 2010 Raising Healthy Eating and Active Living Kids in Alberta surveys of grade five students aged primarily 10-11 years and their parents in the Canadian province of Alberta. We applied a random split sample approach. Two-thirds of the sample (modeling sample) was used for the estimation of the EQ-5D-Y VAS. The remaining one-third sample (validation sample) was used for the examination of the prediction accuracy of the estimation model. Multilevel linear regression was used to estimate EQ-5D-Y VAS score and produce EQ-5D-Y index values from the children's self-rated states described in the EQ-5D-Y and the accompanying VAS values. RESULTS The mean EQ-5D-Y VAS-based index value was 0.891 (SD 0.133) in the modeling sample and 0.885 (SD 0.134) in the validation sample. The own VAS-based index generally showed logical consistency, with lower values for health states that were logically worse. There was no statistically significant difference between the observed and the predicted VAS values in this sample. CONCLUSIONS This study elicited a value set for health states defined by the EQ-5D-Y that is based on respondents' own VAS ratings from a large representative sample of Canadian children. Future study is needed to validate this type of value set among different age groups of children.
Collapse
Affiliation(s)
- X Y Wu
- Department of Public Health Sciences, School of Public Health, University of Alberta, 8303-112 Street, Edmonton, AB, T6G 2 T4, Canada,
| | | | | | | |
Collapse
|
29
|
Health-related quality of life at median 12 months after aneurysmal subarachnoid hemorrhage, measured with EuroQoL-5D. Acta Neurochir (Wien) 2013; 155:587-93. [PMID: 23325515 DOI: 10.1007/s00701-012-1612-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/27/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND A measurement of quality of life (QoL) should cover the important aspects of daily life and be easy to perform. Ease of performance is especially important for patients with spontaneous subarachnoid haemorrhage (SAH), since fatigue and cognitive disabilities are known sequeles. EuroQoL (EQ-5D) is a preference-based instrument measuring QoL, based on self-reported health status in five dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort and Anxiety/Depression. In the present study EuroQoL was used in patients with aneurysmal SAH (aSAH) in comparison with a Swedish reference population. We also determined the extent to which demographic characteristics and clinical parameters predicted outcome. METHODS Seven hundred fifty-five patients with aSAH were studied after a median 12 months. The proportion of patients in the best QoL category for each dimension was compared with the corresponding proportion in an age matched reference population. Disease severity was measured using the World Federation of Neurosurgical Societies' SAH grading system and the Fisher scale. The extent to which demographic and clinical factors predicted outcome was evaluated using linear regression. RESULTS Aneurysmal SAH patients generally had a worse QoL compared with the reference population, in all five dimensions of EQ-5D. In the patient population, disease severity predicted worse outcome in all five dimensions. Female gender and surgery as treatment method (in the case of anterior aneurysms) predicted worse outcome in Usual Activities and Anxiety/Depression. CONCLUSION The nature of the sequeles after SAH depends on severity of disease, gender and treatment method. These factors should be more emphasised in planning rehabilitation.
Collapse
|
30
|
Lundqvist A, Samuelsson K. Return to work after acquired brain injury: A patient perspective. Brain Inj 2012; 26:1574-85. [DOI: 10.3109/02699052.2012.698363] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Ronne-Engström E, Enblad P, Lundström E. Outcome after spontaneous subarachnoid hemorrhage measured with the EQ-5D. Stroke 2011; 42:3284-6. [PMID: 21998065 DOI: 10.1161/strokeaha.111.626283] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The EQ-5D measures quality of life based on self-reported health status in 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. In this study, the EQ-5D was evaluated as an outcome measure for patients with subarachnoid hemorrhage. METHODS The EQ-5D was completed in 710 patients 9 months after subarachnoid hemorrhage. Relevant demographic and clinical factors were evaluated as predictors of the 5 outcome dimensions in a series of linear regression models. RESULTS Worse health status in mobility, self-care, and usual activities was predicted by increasing age and by a more severe disease as indicated by the presence of an aneurysm, worse clinical condition at admission, or more blood on the CT scan. Younger age and female gender predicted worse health status regarding anxiety/depression. CONCLUSIONS The evaluation of the EQ-5D reveals age-related differences in the nature of the challenges faced by these patients.
Collapse
Affiliation(s)
- Elisabeth Ronne-Engström
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, 751 85 Uppsala, Sweden.
| | | | | |
Collapse
|
32
|
Wallander HM. Congenital clubfoot. Aspects on epidemiology, residual deformity and patient reported outcome. Acta Orthop 2010; 81:1-25. [PMID: 21114377 DOI: 10.3109/17453671003619045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Henrik M Wallander
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-75185 Uppsala, Sweden.
| |
Collapse
|
33
|
Norman R, Cronin P, Viney R, King M, Street D, Ratcliffe J. International comparisons in valuing EQ-5D health states: a review and analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:1194-200. [PMID: 19695009 DOI: 10.1111/j.1524-4733.2009.00581.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify the key methodological issues in the construction of population-level EuroQol 5-dimensions (EQ-5D)/time trade-off (TTO) preference elicitation studies. METHOD This study involved three components. The first was to identify existing population-level EQ-5D TTO studies. The second was to illustrate and discuss the key areas of divergence between studies, including the international comparison of tariffs. The third was to portray the relative merits of each of the approaches and to compare the results of studies across countries. RESULTS While most articles report use of the protocol developed in the original UK study, we identified three key areas of divergence in the construction and analysis of surveys. These are the number of health states valued to determine the algorithm for estimating all health states, the approach to valuing states worse than immediate death, and the choice of algorithm. The evidence on international comparisons suggests differences between countries although it is difficult to disentangle differences in cultural attitudes with random error and differences as a result of methodological divergence. CONCLUSIONS Differences in methods may obscure true differences in values between countries. Nevertheless, population-specific valuation sets for countries engaging in economic evaluation would better reflect cultural differences and are therefore more likely to accurately represent societal attitudes.
Collapse
Affiliation(s)
- Richard Norman
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Business, University of Technology, Sydney, NSW 2007, Australia.
| | | | | | | | | | | |
Collapse
|
34
|
Holst M, Strömberg A, Lindholm M, Willenheimer R. Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity. SCAND CARDIOVASC J 2009; 42:316-22. [DOI: 10.1080/14017430802071200] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
35
|
Abstract
BACKGROUND Health status measures used to quantify outcomes for economic evaluation must be capable of representing health gain in a single index, usually calibrated in terms of the social preferences elicited from "the relevant population." The general problem faced in the majority of countries where social preferences are required for cost-effectiveness analysis is the absence of a value set based on domestic data sources. OBJECTIVES This article establishes a methodology for estimating domestic visual analog scale (VAS)-based values for EQ-5D health states by adjusting data sets from countries where valuation studies have been carried out. RESEARCH DESIGN building upon the relationship between the values for respondents' real health states and hypothetical health states, 2 models are investigated. One assumes that the link between VAS scores for real and hypothetical health state is constant across 2 countries (R1), whereas the other adopts the assumption that the relationship of VAS scores for hypothetical heath states between 2 countries functionally corresponds to variation in scores for real health states (R2). Data from national UK and US population surveys were selected to test both methods. RESULTS The R2 model performed better in generating estimated scores that were closer to observed values. CONCLUSIONS The R2 model seems to offer a viable method for estimating domestic values of health. Such a method could help to bridge the gap between countries as well as region within a country.
Collapse
|
36
|
Bachrach-Lindström M, Karlsson S, Pettersson LG, Johansson T. Patients on the waiting list for total hip replacement: a 1-year follow-up study. Scand J Caring Sci 2008; 22:536-42. [DOI: 10.1111/j.1471-6712.2007.00567.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
37
|
Holst M, Strömberg A, Lindholm M, Willenheimer R. Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure. J Clin Nurs 2008; 17:2318-26. [DOI: 10.1111/j.1365-2702.2008.02295.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
38
|
Reigstad O, Siewers P, Røkkum M, Espehaug B. Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: follow-up of 75 hips for 15-18 years. Acta Orthop 2008; 79:194-202. [PMID: 18484244 DOI: 10.1080/17453670710014978] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The long-term results of uncemented total hip arthroplasties vary widely due to differences in design, metal alloy, coating, surface structure, and porosity. PATIENTS AND METHODS We retrospectively studied 75 cementless Zweymuller SL stems in combination with Endler titanium-backed threaded cups (Z-E) in 70 patients. 35 patients were women, and the mean age at surgery was 52 (24-68) years. 16 patients died and 1 emigrated, 7 patients (of which 1 later died) subsequently underwent revision, and the remaining 47 patients with 50 original arthroplasties were followed up after a median of 16 (15-18) years. RESULTS Revision of 8 hips resulted in an 18-year Kaplan-Meier estimated overall survival rate of 88% (CI: 79-96). 6 of 7 cup revisions were due to liner wear and osteolysis, and 1 was due to aseptic loosening. 2 of 3 stem revisions were due to femoral loosening and 1 was due to fracture of the neck of the stem. The clinical results were good, with a mean Harris hip score of 89 (54-100). Half of 70 hips in 65 patients had ectopic bone formation. All unrevised implants were radiographically stable, with a mean liner wear of 0.07 mm/year. INTERPRETATION These long-term results demonstrate that the combination of a Zweymuller SL stem and an Endler titanium-backed screw cup is a good hip arthroplasty in young and active patients. A prefixed polyethylene liner is a drawback, necessitating exchange of the whole cup in cases with polyethylene wear.
Collapse
|
39
|
Ferreira LN, Ferreira PL, Pereira LN, Brazier J. An application of the SF-6D to create heath values in Portuguese working age adults. J Med Econ 2008; 11:215-33. [PMID: 19450081 DOI: 10.3111/13696990801983524] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study describes the health-related quality of life (HRQOL) of the Portuguese working age population and investigates sociodemographic differences. METHODS Subjects randomly selected from the working age population (n=2,459) were assessed using the SF-36v2 and converted into the preference-based SF-6D. RESULTS The mean SF-6D utility value was 0.70 (range 0.63-0.73). The mean utility value was lower for the lower educational level than for the highest. Women, people living in rural areas and older adults reported lower levels of utility values. Non-parametric tests showed that health utility values were significantly related to employment; unskilled manual workers reported utility values lower than non-manual workers. For different diseases, mean utility values ranged from 0.58 (sexual diseases) to 0.66 (hepatic conditions). Cluster analysis was adopted to classify individuals into three groups according to their answers to the SF-6D dimensions. Multinomial logit regression was used to detect sociodemographic characteristics affecting the probability of following each cluster pattern. This study yielded normative data by age and gender for the SF-6D. CONCLUSIONS The authors conclude that SF-6D is an effective tool for measuring HRQOL in the community so that different population groups can be compared. The preference-based measure used seems to discriminate adequately across sociodemographic differences. These results allow a better understanding of the impact of sociodemographic variables on the burden of illness perception.
Collapse
Affiliation(s)
- Lara Noronha Ferreira
- School of Management, Hospitality and Tourism, University of the Algarve, Faro, Portugal.
| | | | | | | |
Collapse
|
40
|
Grenthe Olsson B, Sunnerhagen KS. Functional and Cognitive Capacity and Health-Related Quality of Life 2 Years After Day Hospital Rehabilitation for Stroke: A Prospective Study. J Stroke Cerebrovasc Dis 2007; 16:208-15. [PMID: 17845918 DOI: 10.1016/j.jstrokecerebrovasdis.2007.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 05/26/2007] [Accepted: 06/04/2007] [Indexed: 01/03/2023] Open
Abstract
This study prospectively evaluated long-term outcome 2 years after 6-8 weeks of day hospital rehabilitation (DHR) for stroke in younger patients. Assessment findings after discharge from DHR and at follow-up 2 years later using 3 instruments--the FIM (originally known as the Functional Independence Measure), SF-36, and EuroQol (now known as EQ-5D)--were compared. The study group comprised 50 consecutive patients age 18-60 years at the time of their initial stroke who had participated in a prospective study of the effects of DHR after stroke. Living conditions were assessed using the Riks-Stroke stroke care register. Patient handicaps were graded according to the Oxford Handicap Scale. The patients maintained functional and cognitive capacity, as well as self-rated health and health-related quality of life (HRQoL), 2 years after discharge. A significant improvement was also seen in cognitive capacity and in HRQoL as assessed by EuroQol, but in only 1 of the 8 SF-36 domains. The changes in functional capacity and HRQoL were significantly and inversely correlated with the scores at discharge from DHR. Follow-up scores for EuroQol were correlated with scores for physical and cognitive capacity. Women demonstrated less improvement in EuroQol scores than men. Our findings indicate that most stroke patients who sustained initial acute stroke at age 18-60 years and received 6-8 weeks of DHR poststroke maintained functional and cognitive capacity as well as HRQoL after 2 years. Some patients even may have improved their cognitive capacity and HRQoL.
Collapse
Affiliation(s)
- Barbro Grenthe Olsson
- Institute of Clinical Neuroscience-Rehabilitation Medicine, Sahlgrenska Academy, Göteborg University, Rehabilitation Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | |
Collapse
|
41
|
Shaw JW, Johnson JA, Chen S, Levin JR, Coons SJ. Racial/ethnic differences in preferences for the EQ-5D health states: results from the U.S. valuation study. J Clin Epidemiol 2007; 60:479-90. [PMID: 17419959 DOI: 10.1016/j.jclinepi.2006.08.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 08/01/2006] [Accepted: 08/21/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined differences in preferences for the EQ-5D health states among blacks, Hispanics, and others living in the United States. STUDY DESIGN AND SETTING A multi-stage probability sample was selected from the adult U.S. population. Each respondent valued a subset of the 243 EQ-5D health states. Regression analysis was used to analyze differences in mean valuations for 13 health states among the racial/ethnic groups. First, we compared unadjusted mean valuations among the three groups. Second, we evaluated differences in mean valuations among the groups after adjusting for other sociodemographic characteristics. Third, we evaluated the impact of race/ethnicity on estimates derived from the U.S. health state valuation (i.e., D1) model. RESULTS Valuations differed among the groups for seven of the 13 health states, and these differences persisted after adjusting for other sociodemographic factors. Blacks appeared to perceive extreme health problems to be associated with less disutility than did members of the other two groups. CONCLUSION Within the United States, there exist racial/ethnic differences in the perceived desirability of the EQ-5D health states that cannot be readily explained by socioeconomic disparities.
Collapse
Affiliation(s)
- James W Shaw
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, M/C 871, Chicago, IL 60612-7231, USA.
| | | | | | | | | |
Collapse
|
42
|
Luo N, Wang Q, Feeny D, Chen G, Li SC, Thumboo J. Measuring health preferences for Health Utilities Index Mark 3 health states: a study of feasibility and preference differences among ethnic groups in Singapore. Med Decis Making 2007; 27:61-70. [PMID: 17237454 DOI: 10.1177/0272989x06297103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the health preferences of Southeast Asians. The authors therefore investigated the feasibility of measuring health preferences of Chinese, Malays, and Indians in Singapore and compared their preference scores. METHODS A stratified random sample of the Singaporean general population was interviewed to measure preferences for a set of health states defined by the Health Utilities Index Mark 3 (HUI3) using both the rating scale (RS) and the standard gamble (SG) methods. Feasibility of preference measurement was assessed using ratings of measurement tasks, task completion rates, and ranking of preference scores. Differences in preference scores across Chinese, Malays, and Indians were examined using analysis of variance models. RESULTS Among 245 interviewed respondents (Chinese: 110, Malays: 73, Indians: 62), 97.1% and 95.1% successfully completed all the RS and SG measurement tasks, respectively; 70.1% and 75.3% judged the RS and SG tasks as "easy" or "very easy," respectively. Interviewers rated 69.4% and 75.0% of these respondents as having "full comprehension" for the RS and SG tasks, respectively; "full concentration" was observed in 84.1% and 84.0% of these respondents for the RS and SG tasks, respectively. There were no significant differences in mean preference scores across Chinese, Malays, and Indians, with and without adjustment for effects of confounding variables. CONCLUSIONS RS and SG are feasible methods for measuring health preferences for Asians in Singapore; it appears that Chinese, Malays, and Indians in Singapore have similar preferences for HUI3 health states.
Collapse
Affiliation(s)
- Nan Luo
- Centre for Health Services Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | |
Collapse
|
43
|
Kiessling A, Henriksson P. Time trends of chest pain symptoms and health related quality of life in coronary artery disease. Health Qual Life Outcomes 2007; 5:13. [PMID: 17341296 PMCID: PMC1821316 DOI: 10.1186/1477-7525-5-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 03/06/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is at present a lack of knowledge of time trends in health related quality of life (HRQL) in common patients with coronary artery disease (CAD) treated in ordinary care. The objective of this study is to assess and compare time trends of health related quality of life (HRQL) and chest pain in patients with coronary artery disease. METHODS 253 consecutive CAD patients in Stockholm County, Sweden--197 males/56 females; 60 +/- 8 years--were followed during two years. Perceived chest pain symptoms and three global assessments of HRQL were assessed at baseline, after one and after two years. EuroQol-5 dimension (EQ-5D) with a predefined focus on function and symptoms; the broader tapping global estimates of HRQL; EuroQol VAS (EQ-VAS) and Cardiac Health Profile (CHP) were used. Chest pain was ranked according to Canadian Cardiovascular Society (CCS). Change in HRQL was analysed by a repeated measurements ANOVA and chest pain symptoms were analysed by Friedman non-parametric ANOVA. RESULTS Perceived chest pain decreased during the two years (p < 0.00022); CCS 0: 41-51%; CCS 1: 19-15%; CCS 2: 31-27%; CCS 3: 5-4% and CCS 4: 4-2%. By contrast, HRQL did not change: EQ-5D: 0.76 (CI 0.73-0.79) -0.78 (CI 0.75-0.81), EQ-VAS: 0.68 (CI 0.66-0.71)-0.68 (CI 0.65-0.71) and CHP: 0.66 (CI 0.64-0.69) -0.66 (CI 0.64-0.69). CONCLUSION HRQL did not increase despite a reduction in the severity of chest pain during two years. This implies that the major part of HRQL in these consecutive ordinary patients with CAD is unresponsive to change in chest pain symptoms.
Collapse
Affiliation(s)
- Anna Kiessling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Peter Henriksson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
44
|
Kołtowska-Häggström M, Jonsson B, Isacson D, Bingefors K. Using EQ-5D to derive general population-based utilities for the quality of life assessment of growth hormone deficiency in adults (QoL-AGHDA). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:73-81. [PMID: 17261118 DOI: 10.1111/j.1524-4733.2006.00146.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Disease-oriented quality of life (QoL) measures that are not preference-based lack legitimacy for direct use in cost-utility analyses. This has prompted the search for other methods for deriving utilities. The QoL Assessment of Growth Hormone Deficiency in Adults questionnaire (QoL-AGHDA) is a disease-oriented measure used to assess impairment in QoL in adults with growth hormone deficiency. The present study was designed to generate a model for deriving utilities from the QoL-AGHDA. METHODS The EQ-5D, the QoL-AGHDA, and demographic questions were mailed to a random sample (n = 3005) of the Swedish population (response rate 65%). Multiple regression analysis was used to obtain cross-validated parameters of QoL-AGHDA-based utilities. Two models were developed (simple and full versions). The simple version used the EQ-5D(index) (derived from European values) as the dependent variable, and age, sex, and QoL-AGHDA score as independent variables in a regression analysis. The full model utilized all available demographic information. The QoL-AGHDA scores were thus transformed into a single score (0-1), corresponding to the QoL-AGHDA-based utility. RESULTS The simple transformation algorithm was U (QoL-AGHDA-based utilities) = 1.05 - 0.0189 x QoL-AGHDA score - 0.00238 x age - 0.0127 x sex (male = 0; female = 1). The mean of the weighted estimate for the population (n = 1752) was 0.85 (SD 0.10). The estimate for men (n = 861; mean 0.86; SD 0.10) was higher (P < 0.001) than for women (n = 891; mean 0.84; SD 0.10). CONCLUSION For practical reasons, the simple model can be recommended for deriving utilities directly from the QoL-AGHDA for the Swedish population.
Collapse
|
45
|
Dolders MGT, Zeegers MPA, Groot W, Ament A. A meta-analysis demonstrates no significant differences between patient and population preferences. J Clin Epidemiol 2006; 59:653-64. [PMID: 16765267 DOI: 10.1016/j.jclinepi.2005.07.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Revised: 04/01/2005] [Accepted: 07/24/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES To summarize and quantify mean differences between directly elicited patient and population health state evaluations (= preferences) and to identify factors explaining these differences. MATERIALS AND METHODS Two meta-analyses of observational studies comparing directly elicited patient and population preferences for two stratified health state classifications: actual/hypothetical and hypothetical/hypothetical health states. RESULTS Thirty-three articles comparing directly elicited patient and population preferences were included, yielding 78 independent preference estimates. These preference estimates served as input for the two stratified health state classifications. Data on health state assessments, elicitation methods, assessment method, and population characteristics was extracted by one reviewer, and checked by two other reviewers. These parameters were used to explain sources of heterogeneity. Overall, patients' actual health state preferences were not significantly higher than populations hypothetical health state preferences (summary mean difference [SMD] = -0.01, 95% confidence interval [CI] = -0.01, 0.03). Nor did preferences for hypothetical health states differ between patients and population (SMD -0.00, 95% CI = -0.02, 0.02). Most parameters substantially influenced the SMD, although the magnitude and direction differed for the two strata used (all P-values <.05). CONCLUSIONS The actual/hypothetical and hypothetical/hypothetical meta-analyses demonstrated no significant differences between patient and population preferences, suggesting that both can be used to allocate scarce resources.
Collapse
Affiliation(s)
- Maria G T Dolders
- Faculty of Health Science, Department of Health Organisation, Policy and Economics (HOPE), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
46
|
Parkin D, Devlin N. Is there a case for using visual analogue scale valuations in cost-utility analysis? HEALTH ECONOMICS 2006; 15:653-64. [PMID: 16498700 DOI: 10.1002/hec.1086] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This paper critically reviews theoretical and empirical propositions regarding visual analogue scale (VAS) valuations of health states and their use in cost-utility analysis (CUA). A widely repeated assertion in the economic evaluation literature is the inferiority, on theoretical grounds, of VAS valuations. Five common criticisms are: VAS lacks a theoretical foundation; VAS values are not 'choice based'; VAS values are not consistent with utility-under-uncertainty requirements; context and range effects observed in VAS valuation data mean that they cannot even be considered to represent measurable value functions; and when completing a VAS, people are not trying to express values. We address each of these points: the VAS does have a theoretical basis, being entirely consistent with the non-welfarist foundations of QALYs and CUA; the 'choiceless' nature of the VAS is incorrectly judged by stated preference criteria relevant to monetary rather than health state valuations, and VAS valuations do in any case involve an element of choice; because valuations are intended for use in social decision-making, it may be advantageous that VAS values are elicited under conditions of certainty; although there are measurement problems with the VAS, means such as better design and transformations of data can deal with these; and with any method of eliciting values, it is unrealistic to expect people consciously to think in terms of social science constructs such as utilities.Moreover, there are problems, both theoretical and empirical, with alternative methods. Selection of the appropriate valuation method should be based on empirical performance, and in this the VAS has important advantages. We conclude that there are strong grounds for disputing the consensus view against the VAS and challenge those who hold it to deploy more convincing arguments and evidence in favour of alternative methods. However, we identify areas where further research is required to establish and consolidate the potential of the VAS as a valuation method.
Collapse
Affiliation(s)
- David Parkin
- City Health Economics Centre, City University, London, UK.
| | | |
Collapse
|
47
|
Hansson E, Hansson T. The cost-utility of lumbar disc herniation surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 16:329-37. [PMID: 16683121 PMCID: PMC2200698 DOI: 10.1007/s00586-006-0131-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 04/09/2006] [Indexed: 01/29/2023]
Abstract
The cost and utility of surgery for a herniated lumbar disc has not been determined simultaneously in a single cohort. The aim of this study is to perform a cost-utility analysis of surgical and nonsurgical treatment of patients with lumbar disc herniation. Ninety-two individuals in a cohort of 1,146 Swedish subjects underwent lumbar disc herniation surgery during a 2-year study. Each person operated on was individually matched with one treated conservatively. The effects and costs of the treatments were determined individually. By estimating quality of life before and after the treatment, the number of quality adjusted life years (QALY) gained with and without surgery was calculated. The medical costs were much higher for surgical treatment; however, the total costs, including disability costs, were lower among those treated surgically. Surgery meant fewer recurrences and less permanent disability benefits. The gain in QALY was ten times higher among those operated. Lower total costs and better utility resulted in a better cost utility for surgical treatment. Surgery for lumbar disc herniation was cost-effective. The total costs for surgery were lower due to lower recurrence rates and fewer disability benefits, and surgery improved quality of life much more than nonsurgical treatments.
Collapse
Affiliation(s)
- Elisabeth Hansson
- Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska Academy, Göteborg University, Goteborg, Sweden.
| | | |
Collapse
|
48
|
Horneman G, Folkesson P, Sintonen H, von Wendt L, Emanuelson I. Health-related quality of life of adolescents and young adults 10 years after serious traumatic brain injury. Int J Rehabil Res 2006; 28:245-9. [PMID: 16046918 DOI: 10.1097/00004356-200509000-00007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate health-related quality of life (HRQoL) in a population-based group of young adults with serious traumatic brain injury (TBI) acquired 10 years earlier. In the time period 1987--1991, all 165 residents (<18 years of age) in the south-western health care region of Sweden who had suffered a serious TBI were followed up. Of these, 109 (67%) participated in this follow-up study, which was conducted using the 15-dimension (15D) HRQoL instrument. Their HRQoL was compared with that of 1,039 individuals drawn randomly from the National Population Register for the Finnish Health Care Survey 1995/1996 and matched for age and sex. Nine (mobility, vision, hearing, eating, speech, mental status, depression, distress and usual activities) of the 15 dimensions were significantly aberrant in the TBI group. This TBI group differed markedly from children with organ transplantation, as the transplantation children did not differ from a control group in terms of HRQoL. Compared with other groups of children with congenital or long-lasting conditions, the TBI group had more medical and mental problems.
Collapse
Affiliation(s)
- Göran Horneman
- Department of Psychology, Göteborg University, Sweden, Göteborg University, Sweden.
| | | | | | | | | |
Collapse
|
49
|
Hansson E, Hansson T, Jonsson R. Predictors for work ability and disability in men and women with low-back or neck problems. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 15:780-93. [PMID: 15937677 PMCID: PMC3489465 DOI: 10.1007/s00586-004-0863-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 09/23/2004] [Accepted: 12/03/2004] [Indexed: 11/26/2022]
Abstract
In many countries back and neck problems are the most common reason for work incapacity. Numerous studies have looked for reliable predictors of return to work (RTW) or not return to work (NRTW) for those incapacitated, but with few exceptions their predictive and detective ability has been limited. We aimed to perform a comparative study of various commonly used health measures ability to predict RTW or NRTW in a cohort of men and women sick-listed for more than 28 days due to low-back pain (LBP) or neck pain (NP). A cohort of 1,575 men and women sick-listed more than 28 days due to back or neck problems was asked to answer ten different health measures (scales) about various aspects of health status (health related quality of life, pain, back function and depressivity) at four occasions during a 2-year period. A statistical diagnostic test was used to study how well the subject's values on these scales would serve as a predictor for work resumption. There was an improvement from day 28 up until 2 years, reflected by the different scales, more pronounced for LBP than for NP patients and for men with LBP compared with women with LBP. For all separately tested scales EuroQol (EQ-5D) had the highest overall ability to predict RTW or NRTW irrespective of gender, diagnoses or duration of the problems. When RTW or NRTW were predicted in a cohort of sick-listed low-back or neck patients, EQ-5D had outstanding properties in this respect irrespective of gender, diagnosis or elapsed time during this 2-year study.
Collapse
Affiliation(s)
- Elisabeth Hansson
- Department of Orthopaedics, Sahlgrenska University Hospital, Bruna stråket 11, 413 45 Göteborg, Sweden.
| | | | | |
Collapse
|
50
|
Cost of lipid lowering in patients with coronary artery disease by Case Method Learning. Int J Technol Assess Health Care 2005. [DOI: 10.1017/s0266462305050245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives:This investigation was undertaken to study the costs of a Case Method Learning (CML) -supported lipid-lowering strategy in secondary prevention of coronary artery disease (CAD) in primary care.Methods:This prospective randomized controlled trial in primary care with an additional external specialist control group in Södertälje, Stockholm County, Sweden, included 255 consecutive patients with CAD. Guidelines were mailed to all general practitioners (GPs; n=54) and presented at a common lecture. GPs who were randomized to the intervention group participated in recurrent CML dialogues at their primary health-care centers during a 2-year period. A locally well-known cardiologist served as a facilitator. Assessment of low-density lipoprotein (LDL) cholesterol was performed at baseline and after 2 years. Analysis according to intention-to-treat—intervention and control groups (n=88)—was based on group affiliation at baseline. The marginal cost of lipid lowering comprised increased cost of lipid-lowering drugs in the intervention group compared with the primary care control group, cost of attendance of the GP's in the intervention group, and cost of time for preparation, travel, and seminars of the facilitator. Costs are as of 2002 with an exchange rate 1 US$=9.5 SEK (Swedish Crowns).Results:Patients in the primary care intervention group had their LDL cholesterol reduced by 0.5 (confidence interval [CI], 0.1–0.9) mmol/L compared with the primary care control group (p<.05). No change occurred in controls. LDL cholesterol in the external specialist control group decreased by 0.6 (CI, 0.4–0.8) mmol/L. The cost of the educational intervention represented only 2 percent of the drug cost. The cost of lipid lowering in the intervention group, including the cost of the educational intervention, was actually lower than that of patients treated at the specialist clinic—106 US$ per mmol decrease in LDL cholesterol in the intervention group and 153 US$ per mmol decrease in LDL cholesterol in the specialist group. EuroQol 5D Index, which gives an estimate of global health-related quality of life, was 0.80 (CI, 0.75–0.85) in the present cohort.Conclusions:The additional cost of CML was only 2 percent of the drug cost. Assuming the same gain in life expectancy per millimole decrease in LDL cholesterol as in the 4S-study gives a cost per gained quality-adjusted life year of US$ 24,000. This finding indicates that the CML-supported lipid-lowering strategy is cost-effective. The low cost of CML in primary care should probably warrant its use in the improvement of the quality of care in other major chronic diseases.
Collapse
|